Medical History

Introduction

The third issue of History in Focus brings together resources
for the History of Medicine, from antiquity to the twentieth century.
Focus highlights reviews, web sites and books such as The
Cambridge Illustrated History of Medicine, ed. Roy Porter (1996)
which 'not only stimulate ... interest, but also convey the wealth
and breadth of the subject matter', providing 'a useful barometer
to the current state of the discipline' (see Graham
Mooney's review). To find issues on other topics, go to our
home page.

In this issue:

books: key books on Medical History, listed by publisher, with book summaries and links to publishers' pages.

research: information on current and past research in the United Kingdom. Information on the research interests of UK history teaching staff is also available.

epidemic disease in London: A Collection of Working Papers given at the Symposium 'Epidemic Disease in London: from the Black Death to Cholera' held at the Institute of Historical Research, 19 March 1992.

Review Tasters

Roy Porter (1946-2002)

Julia Sheppard's obituary
of 'one the best historians of his generation' reflects on
the life and career of an historian whose 'prolific output
brought social and medical history to new audiences'. One
of his more than 100 books, The Cambridge Illustrated History
of Medicine, is reviewed by
Graham Mooney. An introductory text to the subject, such
as this is, could only benefit from the fact that Professor
Porter was ''in a unique position to bring together other
medical historians of like stature'.

In
his reply Professor Porter
reflects on the pioneering use of visual material in the book,
commenting that the decision in this instance that 'the illustrations
would not just be tacked on as optional extras, or all clumped
together in the middle ... marks a real advance upon almost
any other history of medicine yet written by scholars'.

Mental Health

Reflecting 'the efflorescence in the history of
psychiatry over the course of the last quarter century', the IHR
has commissioned a number of reviews of books examining the history
of mental health and psychiatry. Masters of Bedlam: the Transformation
of the Mad-Doctoring Trade, by Andrew Scull, Charlotte MacKenzie
and Nicholas Hervey (Princeton University Press, 1996), in the words
of Jonathan Andrews, 'represents a
highly successful attempt to locate the lives and works of some
of the most prominent members of Victorian psychiatry's elite in
Britain against a broad cultural, contextual and structural background'.
Dr. Andrews suggests 'that [the book] should in many ways serve
as a model for historians embarking on biographical studies of professional
men, and more generally for anyone concerned with the ways in which
individuals both impacted on and reflected wider historical patterns
and changes'. In his response, Professor
Andrew Scull admits that he is 'naturally delighted that [the]
overall assessment of the book is so positive and laudatory', but
does take issue with the fact that 'virtually every time a historian
reviews my scholarship, s/he seems compelled to allude to or make
an issue of my background as a sociologist'. 'Sociologists do not
have a good name among many historians, very often with good reason',
but nonetheless, 'the study of human beings and human societies
requires us to transcend the artificial boundaries that threaten
to limit and distort our understanding, not to embrace or reinforce
them'.

Dr.
Mark Jackson begins his review of Mental Disability in Victorian
England: The Earlswood Asylum 1847-1901, David Wright (OUP,
2001) with his teenage memories of the 'view of the asylum at Earlswood,
visible from the windows of the 7.50 train to London, [which] left
an indelible impression on my young, receptive mind'. Professor
David Wright's history of that same asylum is 'a fine, constructive
and substantial contribution to the history of psychiatry and mental
deficiency'.

The institutional history of insanity is also treated
in Insanity, Institutions and Society, 1800-1914:
a Social History of Madness in Comparative Perspective, ed.
Joseph Melling and Bill Forsythe (Routledge, 1999). Dr.
Anne Borsay points out that 'the strong focus on institutions
during the long nineteenth century provides a natural coherence
which is sustained across the comparative perspective taking in
British India and the Cape Colony as well as Wales, Scotland and
Ireland'. Dr. Joseph Melling responds
to the accusation that is 'morally the most serious for any historian
of insanity', that is, that he or she does not 'permit the insane
a voice', concluding that 'It is, in my view, impossibly romantic
to assume we can rescue the mad from the enormous condescension
of their contemporaries and restore to them a voice that society
denied'.

James Mills's Madness, Cannabis and Colonialism
(St. Martin's Press, 2000), reviewed by Satadru
Sen, 'adds a dimension that has not been adequately explored
in recent studies of colonial institutions of medicine and punishment
in the second half of the nineteenth century: clinics, lock hospitals,
prisons, penal colonies, schools and reformatories'. Professor Sen
notes the prominence given to native voices in the book, establishing
'the indigenous discourse of insanity, which saw madness in terms
of an externally imposed affliction' in contrast to 'the late nineteenth-century
British view of madness as an internal disorder of the lunatic's
body'. In his response, James Mills
highlights his argument that 'individuals even in the midst of such
a colonial and disciplinary institution as the asylum can be driven
by agendas that take no account of the systems and the power of
the coloniser'.

Suicide

The two volumes of Suicide in the Middle Ages (vol. 1,
The Violent against Themselves; vol. 2, The Curse
on Self-Murder) are discussed by Professors
Ralph Houlbrooke and David
d'Avray. Alexander Murray's 'scrupulous and detailed'
first volume (Oxford University Press, 1999) 'deals with suicides
themselves, their motives, and other immediate circumstances
of their deaths'. Professor Houlbrooke muses on the fact that,
while 'suicides have never made up more than a tiny minority
of any known human population', 'the subject has attracted
an increasing amount of attention from social historians driven
to enquire what motives underlay so drastic a response to
human misfortune, and to what extent those motives changed
in the course of time'.

In the second volume, also by Murray (Oxford University Press,
2001), 'the unifying argument of the volume is that harsh
treatment of suicide in the Middle Ages does not derive from
the specific rationality of the dominant religion'.
Professor d'Avray concludes that 'not only historians of many periods,
but also scholars in many disciplines ought to study this
rather amazing book'.

Plagues, Epidemics and Contagion

In his review of Christopher Wills's Plagues:
their Origin, History and Future (Harper Collins, 1996), Dr.
Chris Galley reflects on the dualistic aims of the book: 'small-scale
ones which seek to explain the impact of each individual disease,
and the large-scale one of providing an all encompassing theory
of plagues'. He concludes that it 'is highly readable, but is of
probably only limited interest for most historians'. In his response,
Christopher Wills argues that the
problem has much to do 'with the infamous two cultures and the divide
between them' - 'The point of the book is not that it is supposed
to be a history of the plagues written by a historian. It is an
examination of plagues, broadly defined, by a scientist'.

Michael
Worboys reviews Sheldon Watts's Epidemics and History: Disease,
Power and Imperialism (Yale University Press, 1997), suggesting
that it is 'very much of its time, a "big picture" history of disease
focusing on medicine and public health in non-Western countries'.
Whilst stressing that nothing 'should detract from [his] admiration
of Watts's work', Worboys comments on the fact that the book 'is
based on assumptions that most social historians of medicine will
be uncomfortable with'. Sheldon Watts's
response is framed in order to 'help inform the historical profession
as a whole about recent developments in cultural-medical history'.

Professor Pam Pilbeam's
review of Contagion: Disease Government and the 'Social Question'
in Nineteenth-Century France, by Andrew R. Aisenberg (Stanford University
Press, 1999) notes that the book 'emphasises that the intellectual
debate over contagion and the conflicts between engineers and doctors
had more to do with the careers of individuals than science'. Professor
Pilbeam believes that 'Experts in the history of medicine will welcome
the insights into the minds of nineteenth-century professionals'.
Dr. Aisenberg welcomes the identification
of the key themes in his work, but argues that 'What is missing
in the review ... and what is crucial to the engagement with the
fields of modern French social history and the history of medicine
that is at the centre of this book, is the characterization of the
relationship among these themes'.

In the words of Dr.
Phillip Schofield, 'The study of the Black Death has undergone
something of a renaissance in recent years', and Colin Platt's King
Death: the Black Death and its Aftermath in late Medieval England
(UCL Press, 1996) 'is a work of synthesis which continues this trend'.
He concludes that Professor Platt 'attempts to assess the plague's
overall impact but still, despite his warning to avoid a too strict
division of history, encourages us to see the Black Death as a point
of crisis from which English society made real recovery'. Professor
Platt notes that Dr. Schofield, as a demographer, is inevitably
preoccupied with demographic problems and issues in the book, but
suggests that 'if we currently know less about population history
than the demographers believe we ought, they are themselves at least
partly to blame'.

Sexual Health and Fertility

Professor Virgina Berridge reveals that when she told a colleague
that she was reviewing Sex, Sin and Suffering: Venereal Disease and
European Society since 1870, ed. Roger Davidson and Lesley Hall
(Routledge, 2001) she expressed concern that there was anything
left to write about on the subject. Davidson's and Hall's work,
however, 'demonstrate[s] that quite clearly there is'. Professor
Berridge concludes that 'The production of this volume shows that
the area now has a growing European and international critical mass
of historical interest which should sustain research interest. It
indicates, too, that there are allied areas - youth culture, policy
making in the last fifty years for example, - which await more attention'.

Professor Michael Mason reviews Simon Szreter's 'remarkable and very important book', Fertility, Class and Gender in Britain, 1860-1940 (Cambridge
University Press, 1996). The thrust of the book is 'in effect, that
coincidence has deceived the historians of family sexuality in the
period 1860-1960'. Simon Szreter admonishes historians that 'their
cherished unitary fertility decline is riddled with coincidence'
and, Professor Mason argues, 'If he is right, he has completely
rewritten this tract of English social history, and also created
a model for enquiry into the subject which will be influential for
years to come'.

In reply Dr.
Szreter picks up the theme of 'profitable future directions
for research' and suggests that 'the history of sexuality (which
I understand to be a collective noun embracing all inclinations)
and the history of fertility (also widely interpreted, to include
marriage and its alternatives, non-marital fertility, and infertility)
cannot be understood without intimate reference to each other'.

Chris Nottingham's The Pursuit of Serenity: Havelock
Ellis and the New Politics (Amsterdam University Press, 1999)
is, in the words of Dr. Lesley Hall
'an important book which deserves wide circulation ... perhaps the
only satisfactory extended study yet produced of that important
cultural figure Havelock Ellis and the impact of his writings'.
In his reply, Nottingham concludes
that 'whatever else we may feel about Ellis, we must recognise a
staggeringly successful intellectual career. Largely unaided and
sometimes in the face of nagging privations he took himself from
lower middle class obscurity to an honoured seat in the progressive
firmament'.

Public Health

Dorothy Porter's Health, Civilisation
and the State: a History of Public Health from Ancient to
Modern Times (Routledge, 1999) is reviewed by Professor
Gert H. Brieger. Professor Brieger argues that 'Public
health, though often insufficiently appreciated by the other
specialties of medicine, has since the nineteenth century
helped to bridge the traditional gulf that exists between
individual medicine and the greater society in which it functions.
Thus it is public health, with its emphasis on populations
rather than individual patients, that has provided medicine
its ultimate rationale'. Professor
Porter welcomes the 'thoughtful' treatment of her work,
taking issue only with the treatment of her interpretation
of the work of Thomas McKeown.

The Place and Space of Illness

In her article The Place and Space of Illness:
Climate and Garden as Metaphors in the Robben Island Medical
Institutions, Dr. Harriet Deacon
looks at three Robben Island hospitals in the Cape Colony
during the second half of the 19th century (a leper hospital,
chronic sick hospital and mental asylum), and examines attitudes
towards the natural environment surrounding them. She concludes
that 'The links between environment and society were often
expressed through the medium of ideas about healthiness: the
genre of medical topography [and] this understanding of human
interaction with the environment did not vanish with the advent
of germ theory and scientific medicine. It continues to influence
European attitudes to other countries today as well as struggles
within former colonial territories over land and access to
natural resources'.

Medicine in the English Middle Ages

Peregrine Horden's
view that 'Much of the very best synoptic writing on the medieval
medicine of any country has, in recent decades, been elicited by
the English evidence' is borne out by Faye Getz's Medicine in
the English Middle Ages (Princeton University Press, 1998).
He suggests that 'Getz's work has revealed a rare combination of
strengths' and that the book should be viewed as 'a feat of interpretation
which no student of the subject can creditably ignore'.

Epidemic Disease in London

We would like to thank the Centre for Metropolitan
History for allowing us to include their publication Epidemics
in London in this issue. This is taken from a collection of
working papers given at the Symposium 'Epidemic Disease in London:
from the Black Death to Cholera' held at the Institute of Historical
Research, 19 March 1992.

In a paper entitled Plague in London: Spatial
and Temporal Aspects of Mortality, Graham Twigg questions whether
instances of epidemic disease in Britain between 1348 and 1665 can
really be attributed to the plague. He contends that 'A multi-origin
high death-rate would doubtless complicate matters but must be considered
as a possibility'. Meanwhile, the practicalities of disposing of
the dead are addressed by Vanessa Harding in Burial
of the Plague Dead in Early Modern London . She observes that
by the seventeenth century 'mortality rates were higher' and that
the 'absolute numbers of dead' were 'very much greater further from
the centre'. The environment of London itself and its role in epidemics
is considered in Epidemics and the Built
Environment by Justin Champion. He provides a 'survey [of] some of
the approaches that can be employed to explore the social topography
of disease in metropolitan spaces'.

Meanwhile in Discourses
of the Plague in Early Modern London, Margaret Healy observes
that the 'the discourses of the plague handed down to us from the
sixteenth century reveal a particularly interesting story of the
complex interplay between religion, politics and medicine'. The
role of medicine is analysed by Anne Hardy in The
Medical Response to Epidemic Disease During the Long Eighteenth
Century. She asserts that 'individualism seems to be the key
to the eighteenth-century response to epidemic diseases......Medical
treatment, and the medical response to illness, centred on the individual
patient, and did not extend from the individual to the implications
for society at large'. In 'Epidemics and Skeletal
Populations: Problems and Limitations', Margaret Cox considers
the research challenges posed when contemporary documentation of
death is compared against the evidence that modern scientific methods
can yield - 'excavation of the crypt beneath Christ Church .. was
undertaken to retrieve a documented skeletal sample which would
serve as a means of testing the reliability of the then currently
employed osteological and forensic methodology'.